Teen Health in the
Finance Committee Passes Amendment to Welfare Reform Bill Supporting 'Abstinence-First'
Sex Ed Programs
The Senate Finance Committee yesterday passed
a welfare reform bill, known as the Work, Opportunity and Responsibility for Kids
Act of 2002, that includes funding for both abstinence-only and "abstinence-first"
sex education programs, the Washington Times reports. The bill, which is a revision
of the 1996 Welfare Reform Act that is set to expire in September, would continue
to provide $50 million each year in funding for abstinence-only education programs,
a provision that is also included in the House version of the bill (HR 4737) that
was passed last month (Wetzstein, Washington Times, 6/27). However, the committee
also approved an amendment by Chair Max Baucus (D-Mont.) that would allocate $50
million each year for "abstinence-first" sex education programs, which
would encourage abstinence but could also teach children about contraception (Peterson,
National Journal News Service, 6/26). Currently, every state except for California
receives federal abstinence-only education funding provided through the 1996 welfare
reform legislation (Kaiser Daily Reproductive Health Report, 5/17).
groups and newspapers commented on yesterday's Senate action on the welfare bill.
A summary of some of these statements follows:
*HHS: The Finance committee-passed
bill "falls far short of President Bush's welfare reform reauthorization
principles," HHS Secretary Tommy Thompson stated, adding that the full Senate
should consider legislation that is "more in line with Bush's principles"
(HHS release, 6/26).
*New York Times: A Times editorial expresses support
for Baucus' abstinence-first amendment, in part because it "modif[ies] the
government's blinkered approach" to sex education funding. Abstinence-only
programs are a "recipe for disaster," and American teenagers must be
provided with "information that could avert pregnancies or protect them from
a fatal [HIV] infection should they become sexually active," the editorial
concludes (New York Times, 6/26).
*Planned Parenthood Federation of America:
Although PPFA "appreciates" the committee's effort to address sex education,
Congress "needs to do more to ensure that all our children get medically
accurate information necessary to protect their health," Planned Parenthood
President Gloria Feldt said, adding that "[c]omprehensive [sex education]
programs work best" (Planned Parenthood release, 6/26).
Information and Education Council of the United States: Young Americans want
"medically accurate information and education" about sex, not abstinence-only
programs that are "fear-based, biased and misrepresent the effectiveness
of contraception and condoms," SIECUS President Tamara Kreinin said.
She added that the final bill passed by the Senate should allow states "greater
flexibility to craft an appropriate approach to intervention programs most suitable
for their citizens" (SIECUS release, 6/25).
Education, Abstinence Efforts Not Effectively Reaching Teens, BMJ Study Says
Sex education and abstinence programs directed at teens are not having
the intended effect of lowering teen pregnancy rates, according to study in this
week's BMJ, the Toronto Globe and Mail reports (Honey, Toronto Globe and Mail,
6/14). The study says that such programs are ineffective at causing teens either
to delay sexual activity or to use contraception once they do begin having sex.
A research team led by Dr. Alba DiCenso of McMaster University in Canada conducted
a meta-analysis of 26 studies of sex education programs targeted at 11- to 18-year-olds
in the United States, Canada, Australia, New Zealand and Europe. They found that
pregnancy prevention programs overall are not working, "and in some cases,
simply make things worse" (Canadian Press, 6/14). DiCenso's team identified
four abstinence programs in which the pregnancy rate among participants was 50%
higher than the rate among teens who did not take part in the programs. Although
pregnancy prevention programs overall did not appear to be effective among teens,
the authors cautioned that the results may be slightly skewed because most of
the studies were conducted among teens who were African-American or Hispanic,
populations that often have high pregnancy rates overall. These same pregnancy
prevention programs "may be more successful in other populations," the
authors noted (Agence France-Presse, 6/14).
of the authors' recommendations for improving pregnancy prevention strategies
aimed at teens are outlined below:
*Researchers should take a closer look
at teenagers who "do, and don't, get pregnant" to better determine which
groups are at higher risk for teen pregnancy.
*Researchers should also more
closely examine programs in countries such as the Netherlands, which have low
teen pregnancy rates.
*Researchers may wish to review programs that have
been effective among teens at preventing other high-risk behaviors, such as drug
and alcohol use, to identify health behavior modification strategies that are
effective with that age group.
*Programs should seek to involve parents
on a wider scale, the authors said, noting that teens have indicated that they
would prefer to get sex education messages from their parents rather than their
peers (Canadian Press, 6/14).
*Programs should focus more on communication
skills and sexual negotiation skills than on anatomy and "scare tactics,"
according to the authors, who noted that none of the interventions reviewed in
the study "focused on strategies for improving the quality of sexual relationships"
among teens (Agence France-Presse, 6/14).
Ranks Country's 'Kid-Friendly' Cities Based on Infant Mortality, Teen Pregnancy,
Low Birthweight Data
Atlanta, Ga., is making the greatest
improvements among large U.S. cities on three child health indicators -- infant
mortality rate, teen birth rate and the number of low-birthweight babies -- according
to a report released yesterday by Population Connection, formerly known as Zero
Population Growth, the Atlanta Journal-Constitution reports (McKenna, Atlanta
Journal-Constitution, 6/10). The "Kid-Friendly Cities Health Improvement
Report Card," part of a series of Population Connection reports, used CDC
statistics from 1990 and 1998 to grade cities on the three criteria. Of the 25
cities with populations of more than two million, Atlanta received the highest
grade, an A-plus, while St. Louis, Mo., received the lowest grade of C-minus.
The report also analyzed data from 140 cities with populations between 100,000
and two million, of which Cedar Rapids, Iowa, received the highest grade, while
Eugene, Ore., received the lowest (Population Connection release, 6/5). The data
for all three indicators were collected "in exactly the same way for the
same populations" in 1990 and 1998. Report findings for the three indicators
are summarized below:
*Infant mortality -- Defined as the death of an infant
who is less than one year old, infant mortality "reflects the well-being
of both mother and child" and is affected by a variety of factors, including
the health of the woman, environmental conditions and socioeconomic status, the
report states. Nationally, the infant mortality rate fell from 9.2 deaths per
1,000 live births in 1990 to 7.2 deaths per 1,000 live births in 1998, an improvement
of 28%. However, disparities between cities remained, with 12 of the 25 largest
cities studied reporting infant mortality rates above the national average in
1998. Racial disparities also remained, with 13.9 deaths per 1,000 live births
recorded for African-American infants, compared to 6.0 deaths for non-Hispanic
whites, 5.8 deaths for Hispanics and 5.5 deaths for Asian/Pacific Islanders in
*Births to teens -- The national rate of births to teenage mothers
also declined slightly over the study period, falling from 12.8% in 1990 to 12.5%
in 1998. Nineteen of the 25 largest cities studied showed improvements, but 17
cities still had teen birth rates higher than the national average in 1998. The
report notes that reducing the rate of births to teenagers is particularly important
because infants born to teens are more likely to have low birthweight and are
at a higher risk of infant mortality than infants born to older women. Children
born to teen mothers are also more likely to live in poverty and less likely to
graduate from high school than other children.
*Low birthweight -- Defined
as less than 2500 grams, or about 5.5 pounds, low birthweight infants are at increased
risk of infant mortality and long-term illness than infants with normal birthweight.
The percentage of low birthweight infants born between 1990 and 1998 rose from
7.0% to 7.6%, a 9% increase, with 13 of the 25 study cities showing no improvement
in the proportion of low-birthweight infants, according to the report. Poverty,
poor maternal health and a lack of prenatal care are all factors that may contribute
to low birthweight. However, data from the National Center for Health Statistics
show that the rise in the rate of low birthweight over the study period was largely
due to increases in the number of multiple births caused by the increased use
of fertility treatments. The percentage of low-birthweight infants fell slightly
among African Americans -- from 13.3% in 1990 to 13.2% in 1998 -- but it remained
"extremely high" compared to the proportion of low-birthweight infants
among other ethnic groups, which in 1998 were 6.4% among Hispanics, 6.6% among
non-Hispanic whites, 7.1% among American Indians and Alaska Natives and 7.4% among
Asian/Pacific Islanders ("Kid-Friendly Cities Health Improvement Report Card,"
Lowering Teen Pregnancy Rates
Population Connection President
Peter Kostmayer said that "[a]ll the cities, regardless of their grade, have
two things in common -- they all have kid-friendly success stories and they all
could do better." He added, "Clearly one thing that we have to do is
find ways to provide more teen pregnancy prevention programs that give young people
access to comprehensive reproductive health care and education" (Population
Connection release, 6/5). Lowering teen pregnancy rates "is key to a higher"
ranking, the Detroit News reports. "Cities that didn't do well with teen
pregnancies didn't do well in the other areas either," Brian Dixon, director
of government relations for Population Connection, said (Morris, Detroit News,
Free Press Profiles Growing Trend of Oral Sex Among Young People
Recent reports that more teenagers and preteens are engaging in oral sex
are causing concern among health officials and educators, some of whom would like
the CDC to begin tracking the oral sex habits of young people, the Detroit Free
Press reports. Teachers in Oakland County, Mich., report that some students are
beginning to "experiment" sexually as young as age 10, and several fifth-
and sixth-grade students have already said that they have "tried" oral
sex. Young people are "embracing an increasingly casual attitude toward oral
sex," and many teens say that the act "is not sex at all," the
Free Press reports. Sex education teachers say that teens are "hearing the
message to choose abstinence or to protect themselves against pregnancy."
However, teens' definitions of concepts such as virginity, oral sex and intercourse
can complicate efforts to communicate abstinence messages, as young people may
engage in oral sex rather than vaginal intercourse to maintain their virginity
and practice safe sex. Lisa Remez, associate editor of a sexual and reproductive
health journal for the Alan Guttmacher Institute, noted that many girls perform
oral sex in order to "remain virgins" while experimenting sexually.
Diane Waggoner, health education consultant for Oakland Schools, stated, "When
I talk to kids about oral intercourse, they look at me funny because they don't
consider it intercourse. A lot of kids think that since they can't get pregnant
with oral sex, they are practicing abstinence and are safe." Dr. Lloyd Kolbe,
director of the CDC's Adolescent and School Health program, stated, "What
young people must understand is that it is possible through oral intercourse to
be infected with HIV and other serious STDs" (Low, Detroit Free Press, 6/11).
Kentucky School District
Examines Ways to Educate Middle School Students About Oral Sex, Disease Transmission
School administrators and parents in Fayette County, Ky., are planning meetings
to address the increasing rates of oral sex and sexually transmitted diseases
among middle school students, the Lexington Herald-Leader reports. Dr. Hatim Omar,
a University of Kentucky specialist in adolescent medicine, said that since January
he has treated at least 10 middle school-aged students for STDs contracted through
oral sex, compared to six such cases in 2001, two in 2000 and two in 1999. Four
students who developed tonsillitis after contracting gonorrhea said that they
had acquired the disease at off-campus parties where oral sex between students
was prevalent. Doctors and school officials say that adolescents often do not
equate oral sex with sexual intercourse, and many young teens believe that oral
sex is "safer than vaginal intercourse." Mike Kennedy, acting health
education coordinator for the school district, said that the district had a coordinated
sex education curriculum until 1990, but now each school determines its own content
for the courses. Kennedy stated that he does not know of any middle school sex
ed classes that currently address the topic of oral sex. Beaumont Middle School
PTA President Debbie Boian said that she wants middle school PTA leaders to discuss
creating programs at each school to talk to students about the risks of disease
transmission from oral sex and other sexual behavior. Pediatrician Tom Pauly stated
that parents and physicians need to "[deal] with incidents directly and speak
bluntly" with middle school students to help them understand both the emotional
and physical consequences of sexual activity. "We advise them to abstain,"
Pauly said, adding that he discusses with middle school-aged patients both the
"medical complications and the psychosocial complications of engaging in
oral sex at such a young age" (Spears, Lexington Herald-Leader, 6/9).
Education is Key, Editorial Says
One "unexpected outcome" of the
emphasis on abstinence in sex education is that young people "aren't clear
on exactly what they should abstain from," leading many to "mistakenly
conclude that any sexual behavior that won't result in pregnancy is safe,"
a Lexington Herald-Leader editorial states. The increased incidence of oral sex
among middle school students suggests that children view this form of sexual activity
as both "less intimate" and "less risky" than sexual intercourse,
the editorial says, even though STDs including herpes, syphilis, chlamydia, gonorrhea,
human papillomavirus and HIV can be spread through oral contact. According to
the Herald-Leader, a belief among young teens that oral sex does not constitute
sex is especially problematic because "youngsters who don't yet consider
themselves sexually active are not likely to be routinely checked for STDs as
part of medical care." While it is "encouraging to see Lexington school
officials and parents deal openly with this sensitive topic," the editorial
concludes that school sex education programs need to do more to "[arm] kids
with the facts about sex," as well as with "the expectation that they'll
become partners in intimate relationships built on trust and respect" (Lexington
Post-Gazette Profiles Debate Over Abstinence-Only Sex Education
The Pittsburgh Post-Gazette on Sunday profiled the debate over public school-based
abstinence-only sex education, which promotes postponing sex until after marriage
and does not include information on contraception. The House of Representatives
has voted to renew funding for abstinence-only education as part of the reauthorization
of the 1996 Welfare Reform Act, which originally allocated $50 million over five
years for states to provide abstinence-only programs. The Senate has not yet considered
the reauthorization bill, but President Bush is "strongly push[ing]"
the bill as a way to combat the country's "sex-saturated culture," despite
conflicting evidence about such programs' efficacy, the Post-Gazette reports.
Rep. Joseph Pitts (R-Pa.) said that lawmakers have a "duty not to send mixed
messages to our youth" by including discussions about birth control in schools.
But Rep. Jim Greenwood (R-Pa.), who personally supports abstinence, believes that
"mixed messages may be best," the Post-Gazette reports. According to
Greenwood, lawmakers are doing a "disservice to teens" by not including
more comprehensive sex education. "Why can't we tell kids the whole truth
and trust them? If all you say is 'just say no,' you'll be laughed out of the
6th and 7th grades," he said (McFeatters, Pittsburgh Post-Gazette, 6/9).
Activists Protest Opening of Rhode Island Teen Reproductive Health Center
group of antiabortion activists on Wednesday protested the opening of a health
center in Pawtucket, R.I., that will provide reproductive health services -- but
not abortions -- to teens, the Providence Journal reports. The center is operated
by Planned Parenthood of Rhode Island and is located in the Women's Care Inc.
clinic every Wednesday from 4:30 p.m. to 7:30 p.m. The teen center will offer
a variety of reproductive health services, including contraceptive education,
emergency contraception, routine gynecological care and testing for pregnancy
and sexually transmitted diseases, to teens ages 13 to 19. Teen peer educators
will provide the majority of the information dispensed at the clinic, and a health
educator, a physician and a nurse practitioner will also staff the center. The
teen center will not offer abortions, but opponents of the clinic say that the
center will "encourage teenagers to have sex, engage in contraception and,
ultimately, seek abortions." But clinic operators say that there is an obvious
need for teen reproductive health services because Rhode Island has the highest
teen pregnancy rate in the Northeast. "Young people need to be informed.
We can encourage abstinence. We can encourage delay (of sexual activity). But
we can't pretend it's not happening," Miriam Inocencio, president of Planned
Parenthood of Rhode Island, said (Castellucci, Providence Journal, 6/6).
CDC Releases 2001 Birth
Statistics; Teen Birth Rate Continues to Decline and Number of Caesarean Births
The overall U.S. teen birth rate fell 5% last year to mark
a new "record low," according to preliminary birth statistics released
yesterday by the CDC. The report found that the overall birth rate dropped among
females ages 15 to 19 from 48.5 births per 1,000 girls in 2000 to 45.9 births
per 1,000 girls in 2001, with the largest gains made among teens between the ages
of 15 and 17, who experienced an 8% decline in births last year. The birth rate
declined among all racial and ethnic groups, with black teenagers experiencing
the greatest decline (8%). The reduction in the number of births to teens is especially
important for the health of both mothers and infants because teens are the least
likely to receive "timely" prenatal care and are more likely to smoke
and give birth to low-birthweight infants. "The research shows us that when
teens postpone parenthood, they improve their lives and the lives of their children,"
HHS Secretary Tommy Thompson said, calling the record low an "important milestone
in our fight against teen pregnancy" (HHS release, 6/6). Researchers are
not sure what factors led to the decline in teen births, but they say that higher
levels of sexual abstinence and better use of contraceptives probably contributed
to the decrease (Wetzstein, Washington Times, 6/7). Sarah Brown, director of the
National Campaign to Prevent Teen Pregnancy, said that the "credit for these
impressive declines goes primarily to teens themselves who are increasingly making
wise decisions about sex and their future." NCPTP President Isabel Sawhill
added that despite the "good news," U.S. teen pregnancy rates remained
"unacceptably high" and called on Congress, which is currently considering
welfare reauthorization legislation, to "mak[e] sure that resources are available
to support effective national, state and community efforts to prevent teen pregnancy"
(NCPTP release, 6/6). James Wagoner, president of Advocates for Youth, said, "We
cannot put the progress we are making in jeopardy. Congress has the opportunity
in the coming months to reverse course and fund pregnancy prevention programs
that the research shows really work. ... We can and must do a better job at prevention"
(Advocates for Youth release, 6/6).
'Redefining' Sex, Engaging in 'Riskier' Sexual Practices
are having sex at younger ages and are engaging in "riskier" sexual
practices, but many "mask their promiscuity by redefining what sex is: only
intercourse counts," the Detroit News reports in an examination of the "conflicting
trends" in teenage sexuality. According to the CDC Youth Risk Survey, the
number of Michigan high school students who reported ever having engaged in sexual
intercourse fell from 54% in 1991 to 45% in 1999 -- a decline many observers have
attributed to an increased emphasis on abstinence. However, the survey did not
address teens' behavior with regard to anal sex and oral sex, two activities that
teens commonly do not categorize as "having sex," the Detroit News reports.
"A fair number [of teens] don't think of oral sex or anal sex as sex, which
is frightening because (the result is) more interplay with different types of
sexual activity between younger and older teens," Lynn Ponton, a professor
of psychiatry at the University of California-San Francisco and author of "The
Sex Lives of Teenagers," said. She added that most teens do not know that
they can acquire sexually transmitted diseases through such contact. The Michigan
Department of Community Health in 2000 reported 8,591 cases of chlamydia among
youth under age 20, with 599 of those cases occurring in teens ages 14 and younger.
Dr. Anju Sawni, an adolescent health specialist at Children's Hospital of Michigan,
added that health professionals are seeing a growing trend in STD cases among
teens aged 13 and 14.
Feminist Women's Health Center